safety and effectiveness of sofia™/sofia™ plus for direct aspiration in acute ischemic stroke

Conditions: Cerebrovascular Stroke; Stroke, Acute; Cerebral Stroke

Summary: sesame is a european, multi-center, single arm, prospective, observational registry. sesame aims to demonstrate that use of sofia™/sofia™ plus catheter for direct aspiration as a first line treatment technique is fast, safe and effective in patients suffering an acute ischemic stroke when assessed at 24 hours, discharge and 90 days after treatment. 250 patients will be enrolled. all patients will be followed for 90 days or until death.

several publications describing the use of aspiration as a first line treatment technique in ais patients have shown superior technical results with similar clinical outcomes to those seen when using a traditional stent retriever. they have also shown decreased procedure time and cost. the aim of this study is to show similar results in terms of speed, effectiveness and safety when sofia™/ sofia™ plus is the catheter used for first line aspiration thrombectomy. the sofia™ (soft torqueable catheter optimized for intracranial access) and sofia™ plus catheter are single lumen, flexible catheters, designed with coil and braid reinforcement. the sofia™ / sofia™ plus catheters have a soft distal tip for easy navigation in tortuous vessels. the tip is steam shapable and the proximal shaft torquable to help steer around challenging bifurcations. the coil and braid construction provides enhanced kink resistance and 1:1 push / pull control. once navigated to the site of the occlusion, the sofia™ / sofia™ plus catheters can be used in conjunction with an aspiration source, such as a pump or syringe, to facilitate aspiration thrombectomy of the occluded vessel. the sofia™ / sofia™ plus catheters have large lumens, developed to maximize aspiration power and capture of thrombus. sesame is a multi-center, single arm, prospective, observational registry of the sofia™/ sofia™ plus catheter in europe. consecutive patients presenting within 6 hours of symptom onset with an anterior circulation large vessel occlusion (lvo) acute ischemic stroke (within the internal carotid artery and internal carotid terminus, middle cerebral -m1/m2 segments) will be treated using aspiration thrombectomy as first intention and site routine practice. devices received ce-mark and will be used according to the 'instructions for use'. the follow-up visits will occur at 24 +/- 12 hours, at patient discharge, and 90+/-14 days post-procedure. furthermore the study design is adaptive, prospectively stating interim analyses with specified stopping rules, which allow for the possibility of the study to terminate early based on either a determination of study success or of the futility to continue further enrollment.

Eligibility criteria:
inclusion criteria: 1. participant is ≥ 18 2. demonstrated occlusion of the distal intracranial carotid artery, middle cerebral artery (m1 or m2) or anterior cerebral artery (a1 or a2) proven by ct and/or mri 3. nihss ≥ 2 and ≤ 30 at screening 4. start of the thrombectomy procedure within 6 hours of the onset of stroke symptoms 5. pre event mrs ≤1 6. patient or patient's legally authorized representative has received information about data collection and has signed and dated an informed consent form exclusion criteria: 1. patient is more than 6 hours from symptom onset 2. rapidly improving neurologic examination 3. evidence of cerebral ischemia in the posterior circulation 4. severe unilateral or bilateral carotid artery stenosis requiring stent treatment 5. presence of an existing or pre-existing large territory infarction 6. absent femoral pulses 7. excessive vascular tortuosity that will likely result in unstable access 8. pregnancy; if a woman is of child-bearing potential a urine or serum beta hcg test is positive 9. known contrast product allergy 10. patient has a severe or fatal comorbidity that will likely prevent improvement or follow up or that will render the procedure unlikely to benefit the patient 11. evidence of intracranial hemorrhage (sah, ich, etc.) imaging exclusion criteria: * significant mass effect with midline shift or intracranial tumor * baseline non-contrast ct or dwi mri evidence of a moderate/large core defined as extensive early ischemic changes of alberta stroke program early ct score (aspects) 0-5

Keywords: acute ischemic stroke thrombectomy aspiration thrombectomy observational study